GENERAL SURGERY RESIDENCY Curriculum Outline SURGICAL COUNCIL ON RESIDENT EDUCATION GENERAL SURGERY RESIDENCY CURRICULUM OUTLINE Patient Care and Medical Knowledge 2011–2012 Surgical Council on Resident Education 1617 John F. Kennedy Boulevard Suite 860 Philadelphia, PA 19103-1847 Tel. 215-568-4000 Fax 215-563-5718 www.surgicalcore.org AN INTRODUCTION TO THIS DOCUMENT In recent years, there has been a call for a bet- ter defined curriculum in general surgery residen- cy training. An important starting point for cur- riculum development is to answer the question “What do we expect our residents to know and be able to do at the end of their training?” As described by the Accreditation Council on Graduate Medical Education, we expect our grad- uating residents to be competent in six areas: patient care and procedural skills, medical knowl- edge, professionalism, communication, practice- based learning, and systems-based practice. In 2004 the General Surgery Residency Committee of the American Board of Surgery (ABS) began to develop a curriculum in general surgery patient care by delineating the specific patient care com- petencies they expected of graduating general surgery residents. An expert consensus process was used to develop this document, with signifi- cant input from the Association of Program Directors in Surgery (APDS) as well as specialty surgical societies. The patient care competency was chosen as the subject for initial curriculum development because many groups involved in surgical educa- tion felt this area was the most in need of defini- tion and attention. The first SCORE patient care curriculum outline was published in April 2008; it has subsequently been revised on an annual basis. An outline of topics for the medical knowl- edge competency was added as of the 2010-2011 edition. This outline should not be viewed as static. It will be reviewed annually to introduce new topics as needed, delete obsolete topics, or change the depth and breadth of existing topics. EXPLANATION OF THE CURRICULUM OUTLINE This document contains a list of approximate- ly 700 patient care topics to be included in a cur- riculum for a five-year general surgery residency - 1 - training program. It also specifies in basic terms the depth and breadth of training that is expected for each (see “Classification System” on page 3). To care for the surgical patient, it is necessary to master knowledge related to specific diseases and operations, but also knowledge of systems and conditions that affect the body as a whole, such as septicemia or coagulopathy. The topics in the medical knowledge portion of the SCORE curriculum are generally of this variety, as well as topics of a general nature such as biostatistics and technical aspects of minimally invasive surgery. The 78 medical knowledge topics are organized into 13 subject matter categories. This outline has been approved as the basis for full curriculum development by the ABS and SCORE. SCORE, with the extensive involvement of the APDS, is developing learning objectives for each topic. Instructional materials are then identified or developed to support the teaching of that topic. Assessment tools are also being devel- oped to determine if residents have actually acquired the desired knowledge and skills, and finally the effectiveness of the entire program will have to be regularly evaluated. When all of these have been accomplished, there will be a complete curriculum. SCORE has created the SCORE General Surgery Resident Curriculum Portal (portal.surgi- calcore.org) for the delivery of instructional con- tent and assessment in support of the curriculum to general surgery residency programs. Learning “modules” are currently available on the portal for most of the topics listed in this booklet, with more to come. Each module features learning objectives, self-assessment questions and various study materials, including textbook chapters, videos and radiologic images. Faculty may assign modules to residents for review; multiple-choice questions are also available to assess resident knowledge. More information about the portal is available from www.surgicalcore.org. - 2 - CLASSIFICATION SYSTEM The patient care curriculum topics are organ- ized into 28 organ system-based categories. Within each category are diseases/conditions as well as operations/procedures. The topics are stratified as follows: Diseases/Conditions Two levels: • BROAD – A graduate should be able to care for all aspects of disease and provide comprehen- sive management. • FOCUSED – A graduate should be able to make the diagnosis, provide initial management/stabi- lization, but will not be expected to be able to provide comprehensive management. Operations/Procedures Three levels: • ESSENTIAL – COMMON – Frequently performed operations in general surgery; specific proce- dure competency is required by end of training (and should be attainable primarily by case vol- ume). • ESSENTIAL – UNCOMMON – Rare, often urgent, operations seen in general surgery practice but not typically done in significant numbers by trainees; specific procedure competency required by end of training (but cannot be attained by case volume alone). • COMPLEX – Not consistently performed by gen- eral surgeons in training and not typically per- formed in general surgery practice. Generic experience in complex procedures is required but not competence in individual procedures. Some residency programs may provide suffi- cient experience for competence in specific pro- cedures. - 3 - PATIENT CARE CURRICULUM OUTLINE CONTENTS BY CATEGORY ....................................................6 1. Abdomen – General..................................6 2. Abdomen – Hernia....................................7 3. Abdomen – Biliary ................................8-9 4. Abdomen – Liver ....................................10 5. Abdomen – Pancreas ............................11 6. Abdomen – Spleen ................................12 7. Alimentary Tract – Esophagus ..............13 8. Alimentary Tract – Stomach ..................14 9. Alimentary Tract – Small Intestine............15 10. Alimentary Tract – Large Intestine ............16 11. Alimentary Tract – Anorectal..................17 12. Endoscopy ..............................................18 13. Breast ......................................................19 14. Endocrine ................................................20 15. Skin and Soft Tissue ..............................21 16. Surgical Critical Care ............................22 17. Trauma ..............................................23-25 18. Vascular – Arterial Disease ............26-28 19. Vascular – Venous..................................29 20. Vascular – Access ..................................30 21. Transplantation ......................................31 22. Thoracic Surgery ..............................32-33 23. Pediatric Surgery ..............................34-35 24. Plastic Surgery ........................................36 25. Genitourinary ..........................................37 26. Gynecology ..............................................38 27. Head and Neck ......................................39 28. Nervous System......................................40 DISEASES BY LEVEL ........................................41 Broad ....................................................41-44 Focused ................................................44-48 OPERATIONS BY LEVEL....................................49 Essential – Common ..............................49-50 Essential – Uncommon ..........................50-51 Complex ..................................................52-54 - 4 - MEDICAL KNOWLEDGE CURRICULUM OUTLINE CONTENTS 1. Anesthesia..............................................55 2. Biostatistics and Evaluation of Evidence ................................................55 3. Fluids, Electrolytes and Acid-Base Balance ..................................................55 4. Geriatric Surgery and End-of-Life Care ........................................................56 5. Immunology............................................56 6. Infection and Antimicrobial Therapy ....56 7. Minimally Invasive Surgery – Principles ................................................57 8. Nutrition and Metabolism......................57 9. Oncology and Tumor Biology ....................57 10. Pharmacology ..........................................58 11. Preoperative Evaluation and Perioperative Care ................................58 12. Transfusion and Disorders of Coagulation ............................................58 13. Wound Healing ......................................59 - 5 - PATIENT CARE Category 1: Abdomen − General Diseases/Conditions BROAD • Acute abdominal pain • Intra-abdominal abscess • Rectus sheath hematoma • Mesenteric cyst FOCUSED • Chronic abdominal pain • Carcinomatosis • Pseudomyxoma peritoneii • Spontaneous bacterial peritonitis • Desmoid tumors • Chylous ascites • Retroperitoneal fibrosis Operations/Procedures ESSENTIAL − COMMON • Insertion peritoneal dialysis catheter • Diagnostic laparoscopy • Open exploratory laparotomy ESSENTIAL − UNCOMMON • Open drainage abdominal abscess COMPLEX • Open retroperitoneal lymph node dissection • Laparoscopic retroperitoneal lymph node dissection • Operation for pseudomyxoma - 6 - Category 2: Abdomen − Hernia Diseases/Conditions BROAD • Inguinal hernia • Femoral hernia • Ventral hernia • Miscellaneous hernias Operations/Procedures ESSENTIAL − COMMON • Open repair of inguinal and femoral hernia •